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Designing capacity rollout plan for neonatal care service system in Korea

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Abstract

Strengthening the infrastructure of the neonatal care service system is an important field of work in Korea. Motivated by the efforts of the Korean government, we address the problem of allocating care capacities to neonatal intensive care units (NICUs) to maximize the demand covered over the planning horizon. To address this problem, we suggest a mathematical model that incorporates three important problem features: (1) a multi-period planning horizon; (2) a hierarchical structure of the neonatal care service system (multi-flow, nested, and non-coherent); and (3) a congestion effect in providing services at each NICU. The model is formulated as a mixed-integer linear programming problem and is applied to the design of neonatal care service system in Korea. By evaluating several scenarios through varying the total amount of budget available, our experimental results highlight insightful information for policy makers to establish their rollout plan. In particular, we evaluate three alternatives to improve the quality of neonatal care services. The first two alternatives are related to increasing care capacities, and the third option is related to limiting inappropriate inflow to NICUs. The experimental results confirm that increasing care capacities by upgrading lower levels of NICUs to higher levels is the most effective policy among the three options. We believe that our model and findings are paramount for the development of better neonatal care service systems.

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Notes

  1. Prior studies have consistently indicated that the growth in women’s participation in social activities is associated with the increase in maternal ages which has been proven as a critical factor of increasing demand for neonatal intensive care services (Cho et al. 2014; Joseph et al. 2005).

  2. Korea provides universal healthcare (i.e., public insurance), and medical providers in Korea generally tolerate low compensation for their medical services. The amount of compensation for obstetrics is especially low. In conjunction with the declining birth rate, many obstetrics and gynecology (OB/GYN) clinics close every year, resulting in fewer OB/GYN physicians and resources and practical issues such as high medical accident rates and the risk of medical disputes.

  3. Since neonatal intensive care typically requires high-level medical treatment skills in an urgent base, it is more likely to occur medical errors or malpractices compared to other types of care which may cause medical disputes or medicolegal problems.

  4. Specifically, as noted in footnote 1 in Sect. 1, we illustrated that the maternal age is associated with the occurrence of high-risk newborn infants (Cho et al. 2014; Joseph et al. 2005).

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Acknowledgements

The author would like to express his gratitude to Professor Taesik Lee (KAIST), Mr. Kyosang Hwang (Ph.D. Candidate, KAIST), and Mr. Taeho Lee (M.S., National Medical Center) who have shared their knowledge for improving this work.

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  1. Center of Public R&D Program Evaluation, Science and Technology Policy Institute, 370 Sicheng-daero, Sejong, Korea

    Hoon Jang

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Jang, H. Designing capacity rollout plan for neonatal care service system in Korea. OR Spectrum 41, 809–830 (2019). https://doi.org/10.1007/s00291-019-00558-9

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